NeuroTalk Support Groups - Do we have an "advocate"?

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- Reflex Sympathetic Dystrophy (RSD and CRPS) (https://www.neurotalk.org/reflex-sympathetic-dystrophy-rsd-and-crps-/)

- - Do we have an "advocate"? (https://www.neurotalk.org/reflex-sympathetic-dystrophy-rsd-and-crps-/94638-advocate.html)

Do we have an "advocate"?

iwanta know if there's an advocate group that can help me as i struggle thru RSD while "fighting" w/worker's comp?? i need someone that can tell me: u need 2 say this or u need 2 do this! i'm not getting treatment i need because of w.c. "crazy people" (who don't know RSD!)..... Help! :confused:

Hi Nancy,
I, too, am in warfare with W.C. !! I injured my ankle at work in '06 and had surgery in '08 and developed RSD..(not sure if the RSD happened before or after surgery, but we think it was after...)
I happened to be in the right place at the right time when a doctor recommended I have an attorney to advocate for me and represent me ...and he recommended some one he knew..
WC wanted to do a QME exam a long time ago with a completely inapporpriate examiner..my attorney intervened and arranged the QME exam with an agreed upon examiner that he trusted...
I anticipate another battle with approval for some equipment and it is comforting to know that the attorney will help me with that ...
It would really be great to have an additional "advocate" in addition to the attorney..maybe some of the RSD organizations can provide some info and insight into such a person!
Thinking of you,
Hope4thebest

Dear Nancy -

You need to speak with a lawyer ASAP. Subject to correction, it is my understanding Cal. declared -- by statute -- about 3 - 4 years ago that RSD and Fibro. woudn't be covered by WC. Period. A horrible thing, but there it is.

That said, if you are still within the statute of limitations for bringing a claim of negligence against your employer, you may be able to do so, where it shouldn't be able to assert the defense of "workers' comp. pre-emption" if RSD is no longer a covered claim for WC purposes. Put it another way, to remove any remedy for your injury could be argued to rise to the level of a "takings" under the Fifth and Fourteenth Amendment of the US Constitution. But please get on this quickly.

Mike

Hello Nancy,

My RSD is not the result of a job injury. However, my long term disability insurance wanted to cancel my benefits. They claimed RSD is a mental not physical condition and they only cover mental conditions for 2 years.
I talked with my physcologist who recommened an attorney who helped to change the insurance companies view.
I recommend you consult an attorney. WC like insurance companies want to get out of paying so they make it soooo difficult to get proper care.
I know how frustrated you must feel. It's bad enough dealing with all that RSD does to our bodies and mind without adding the frustrations of legal matters. However, that's the way the WC system works. They almost force you get an attorney to get proper care and attention. (My husband had a WC injury from his job as a firefighter).
Take care of yourself the stress, alone, from dealing with WC will keep your pain flared.
I hope you can make some progress soon.
Sherrie

Hi FMichael,

When you write that " California declared ---by statute---about 3 or 4 years ago that RSD and Fibro wouldn't be covered by W.C. " what does that entail?
Doe sit mean that you are unable to get life-time medical benefits, or a settlement or? My diagnosis is RSD, confirmed with a second opinion by a reputable university hospital.

W.C. has paid thus far for al my medical expenses, albeit, it's like extracting a needle from a two ton haystack..but eventually they do approve most authorization requests...eventually...

Which statute are you referring to...it has me worried!!!!!
Thanks for the info!!!
I hope you are doing well !
Hope4thebest

thks 4 all ur advice! my accident occurred in my new computer lab - fell down a step where the silver strips hadn't been placed on the steps. broke left wrist in 2 plcs, thus RSD! have been speaking 2 a good attorney.... eventually might result in a claim of negligence against employer. still wish i had a good advocate 2 advise me..... thinking of everyone!

Nancy
Everything will work out ok,,do your part,and rely on the Lord in prayer,,he will deliever you ,, bobber

Quote:

Originally Posted by nancyinLA (Post 540813)

I'll weigh in somewhat on this as I have written reports in the past as a Qualified Medical Evaluator. Injuries that occured or were permanent and stationary on or after 1/1/05, fall under new guidelines where the treatment must be directed in accordance with a book called loosely, the ACOEM Guidelines. This book in turn, falls upon the direction, clinically, of the AMA Guides to Permanent Impairment 5th Ed. (or some silly name) that actually has a section on the rating of RSD/CRPS, pg, 495 I think. My edition of the ACOEM Guides is an online version for which is at my office however, while I am not certain that RSD/CRPS is mentioned in ACOEM, it would be very inconsistent for there to be an impairment rating scale in the AMA Guides and not be in ACOEM. The bad news is, both are very conservative publications that don't fully address RSD/CRPS with the attention they deserve!

For example, the rating scale used in the AMA Guides is not consistent with the bulk of the literature advocated on current diagnosis, relys on a concurrent constellation of 8 or more symptoms and if not all present at the same time, a "no CRPS" diagnosis is warrented and even suggests that factitious disorder and malingering are the root cause.

Soooo.....consequently the WC system will give you little help, Mike is right; the advocate you seek is spelled "A-T-T-O-R-N-E-Y." There is a little wiggle room in that ACOEM does state that if the preponderance of evidence suggest something other than what the AMA Guides recite, you may have a better and more supportive argument going down that road!

If you are unrepresented, you can call the WCAB (worker's compensation appeals board), I believe there is an office in Santa Monica and for sure in Long Beach and ask to speak with the Information and Assistance (I and A) Officer. They are a patient advocate for unrepresented workers

Sorry it's taken me so long to answer Hope4thebest, but this was one of those situations where although I remembered the net result properly, I ran into nothing but frustration in trying to do online statutory research in order to retrace my steps, plus my friend the WC attorney who confirmed my understanding of what SB 899 meant when it passed in 2004 has been in an ICU for the last two weeks.

The good news is as follows: (1) my friend and father of my oldest son's best friend of many years standing is going to pull through and (2) in a published decision of the full (en banc) Workers' Compensation Appeals Board that came down in February of 2009, referred to as the Almaraz-Guzman Opinion, http://www.csims.net/pdf/Almaraz%20-...0en%20banc.pdf, the court held that the presumptions created in the "Schedule for Rating Permanent Disabilities" of the California Department of Industrial Relations, Division of Workers' Compensation, http://www.dir.ca.gov/dwc/PDR.pdf, which in turn incorporates the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment, 5th Edition, are rebuttable.

Now, I know that was an impossibly long and opaque sentence, but what it boils down to is pretty simple. Back in 2004, shortly after he assumed office, Arnold threatened to violate the California Legislature unless it passed "comprehensive workers' compensation reform," and the legislature obliged with the adoption of SB (Senate Bill) 899, the business end of which appears in Labor Code Sec. 4660, embracing the "evidence-based medicine" [Gawd, what a misnomer!] of the AMA Guides. And here's where my memory betrayed me: there is no reference to either CRPS or Fibro in the statute. My recollection now refreshed, I had to have read at the time what the adoption of the AMA Guides would have meant in practice for anyone with those pain conditions. It was this understanding that my friend Ted confirmed when this was going down. (And I realize that my "false memory" was correct in one sense. Everyone knew that the statute as written was designed to relieve industry of the burden of defending against trumped up claims of chronic pain, and if that meant throwing the baby out with the bath, so be it. Claims based on RSD and Fibro would not be allowed.)

For a terrifying screed by a leading physcian regarding the effect of the AMA Guides on (now past) RSD patients, as it appears on the RSD Foundation webpage, check this out: http://www.rsdfoundation.org/test/AMA.html. I would urge everyone to read it closely.

Bottom line: for patients in California, a rebuttable presumption is better than one that's irrebuttable, but a presumption it remains. Or don't try this at home. This is indeed where people need lawyers.

Mike

Quote:

Originally Posted by fmichael (Post 541736)

Thanks Mike. After reading Dr. Kirpatrick's letter and the response from the AMA official who recommended using a different chapter for rating purposes because it is kinder to RSD/CRPS patients, is alarming.

So there are two standards within the "Guides" in which to rate an RSD/CRPS patient. Pg. 343 and Pg 495, the former being apparently much kinder to the patient. So then what will happen is that those examiners who want to hammer the patient will use pg 495 and those who are more sympathetic, will use pg 343. More work for the judges, I guess. I will have to check to see what ACOEM says about this. Only in America!